Expertise in allergy and immunology can aid other medical specialties.docVIP

NOTES OFALLERGYWATCHERS ExpertiseinAllergyandImmunologyCanAidOther MedicalSpecialties S.GunnarO.Johansson,MD,PhD A llergyhas come along way asamedical science since the discovery of Immunoglobulin E (IgE) some 40 exception: InNorway, butnotinSweden, acoughmixture, Tuxi, (Weifa AS, Oslo, Norway), was used that contained pholcodine (PHO), which in principle is a modi?ed mor- phine (MOR). years ago. We have become much more pro?cient in diagnosing and managing classic allergic conditions like asthma, rhinitis, and eczema. However, I am also con- vinced that allergists and immunologists can make valu- able contributions to other medical specialties. Acaseinpointisanesthesiology.Anaphylaxisduring general anesthesia is recognized as a severe problem and a threat to patient safety. Neuromuscular blocking agents (NMBAs) represent the most frequent cause, with suxam- ethonium(SUX)asthesubstancemostofteninvolved.Other To explore the possible effects of this difference in exposure, we decided to perform a comparative study to document theprevalence ofIgEsensitization toPHOinthe 2 countries. As morphine has been suggested as being suitable for the screening of individuals sensitized to the quaternary ammonium ion epitope, the most likely aller- genicepitope forthespeci?c binding ofIgEtotheNMBA, we also tested for sensitization to MOR. The results showed that in Norway 0.4% of persons who donated blood, 3.7% of patients with allergies, and 38.5% of patients with an anaphylactic reaction to NMBAs were sensitized to SUX. The corresponding percentages for MOR were 5%, 10%, and 66.7%, respectively. Among those from Stockholm who donated blood and patients with allergies, none with antibodies toSUXorMORwere found. IgEantibodies toPHOwerefoundin6%ofpersons who donated blood that were from Bergen but in no one agentsarelatex,dextran,andvariousdrugs. 1 Together withmyfriend andcolleague ErikFlorvaag atHaukeland University Hospital inBergen, Norway, and my coworkers at the Depa